Common use of Category 1 Clause in Contracts

Category 1. 23.2.1 Liquidated damages up to $100,000 per violation may be imposed for Category 1 events. For Category 1 events, the Contractor shall submit a written CAPA/PC to DCH for review and approval prior to implementing the corrective action. Category 1 events are monitored by DCH to determine compliance and shall include and constitute the following: · Acts that discriminate among Members on the basis of their health status or need for health care services; and · Misrepresentation of actions or falsification of information furnished to CMS or the State. · Failure to implement requirements stated in the Contractor’s proposal, the RFP, this Contract, or other material failures in the Contractor’s duties. · Failure to participate in a readiness and/or annual review. · Failure to provide an adequate provider network of physicians, pharmacies, hospitals, and other specified health care Providers in order to assure member access to all Covered Services.

Category 1. 23.2.1 Liquidated damages up to $100,000 per violation may be imposed for Category 1 events. For Category 1 events, the Contractor shall submit a written CAPA/PC to DCH for review and approval prior to implementing the corrective action. Category 1 events are monitored by DCH to determine compliance and shall include and constitute the following: · • Acts that discriminate among Members on the basis of their health status or need for health care services; and · • Misrepresentation of actions or falsification of information furnished to CMS or the State. · • Failure to implement requirements stated in the Contractor’s proposal, the RFP, this Contract, or other material failures in the Contractor’s duties. · • Failure to participate in a readiness and/or annual review. · • Failure to provide an adequate provider network of physicians, pharmacies, hospitals, and other specified health care Providers in order to assure member access to all Covered Services.